The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs. The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care plans are communication plans with the addition of autobiographical information. Twenty residents and ten CNAs from two nursing homes participated in the study. Once CCPs were created, CNA participants in one facility received support each day. Following two weeks, CNAs participated in a semi-structured interview. Interviews were transcribed and analyzed using open, axial and selective coding. Findings revealed a core category, meeting resident’s needs through professional support and communication, which describes the progressive process these CNAs underwent to effectively communicate with residents in nursing homes using CCPs. Evolution of this process occurred as CNA participants became familiar with residents. An underlying component facilitating this familiarity was support during CCP implementation. Initially, these CNAs had negative views about nursing home care because they were unsure how to communicate with residents and received little support from higher levels of nursing authority. Over time and with application of CCPs, CNAs became familiar with residents and their communication behaviors. Application of specific communication strategies on CCPs required ongoing support from the investigator/speech-language pathologist which was evident by the comments between CNA participants from each facility. Participants from both facilities reported positive experiences during application of the autobiographical information on the CCPs. This personal information coupled with increased knowledge about resident’s specific communication abilities fostered the formation of a relationship between residents and CNAs. In summary, support during application of CCPs supplements CNAs’ abilities to meet residents’ needs.

Det finns begränsat med forskning kring hur biståndshandläggare inom äldreomsorgen arbetar med ensamhet hos äldre personer. Med anledning av detta är studiens huvudsakliga syfte att undersöka hur biståndshandläggare i Dalarnas kommuner arbetar med att utreda sociala behov till följd av ensamhet hos äldre personer samt att ta reda på vilka kommunala sociala insatser som erbjuds för dessa individer och på vilka grunder. Studien är genomförd utifrån en kvantitativ ansats, där vi har använt oss av en enkät, som innehåller frågor som avser att besvara syftet. Tolkningsramen för analysen av det empiriska materialet utgörs av Lipskys teori om gräsrotsbyråkrati. Studiens resultat visar att det finns behov av att både utöka och utveckla kommunernas utbud av sociala insatser för äldre personer samt att utveckla rutiner för hur man ska arbeta med ensamhet hos äldre personer. Studien påvisar ett behov av mer forskning, både internationell och nationell, kring hur biståndshandläggare arbetar med att identifiera ensamhet hos äldre personer. / There is limited research on how care administrators in elderly care work with loneliness among older people. For this reason, the study's main purpose is to examine how care administrators in Dalecarlian counties are working to investigate the social needs as a result of loneliness among older people and to find out which municipal-based social interventions that are offered for these individuals and on what grounds. The study was conducted based on a quantitative approach, were we have used a questionnaire that includes questions designed to answer the study’s purpose. Interpretative framework for the analysis of the empirical material consists of Lipsky 's theory of street-level bureaucracy. The study’s results show that there is a need to both expand and develop the municipal-based social interventions for the elderly and to develop procedures on how to work with loneliness among older people. The study demonstrates a need for more research, both international and national, about how care administrators are working to identify loneliness among older people.

The present study was designed to empirically validate six theoretically derived cognitive domains (verbal memory, visual memory, working memory, attention-concentration, executive functions, and visuospatial abilities) assessed by a comprehensive battery of neuropsychological tests used in the Geriatric Memory Clinic at the University of North Texas Health Science Center in Fort Worth, Texas. The study examined the extent to which various cognitive dimensions are tapped by this battery in a heterogeneous geriatric sample of 114 patients with cognitive impairments. The proposed six-factor model of cognitive functioning has not been supported. Further exploratory factor analysis arrived at a five-factor solution. Factor pattern of the 23 tests supported the following five dimensions: memory, executive control, attention, visuospatial abilities, and cognitive flexibility.

Les résultats de cette recherche faite auprès de cadres intermédiaires qui sont les gestionnaires des infirmières travaillant dans des programmes de personnes âgées en perte d'autonomie liée au vieillissement(PALV) montrent qu'il est difficile d'y attirer de nouvelles infirmières en raison du peu de popularité du domaine de la gériatrie.Afin d'y attirer des candidates, les cadres peuvent faire valoir le défi de gérer des situations de santé souvent complexes, la flexibilité des horaires de travail,l'autonomie dont elles disposent dans l'organisation de leur travail, le nombre de week-end de travail moins élevé que dans les hôpitaux et l'absence de travail supplémentaire obligatoire. Selon ces cadres, la rétention des infirmières dans de tels programmes PALV ne crée pas problème. Pour favoriser davantage cette rétention, des mesures élaborées d'orientation et d'encadrement des nouvelles infirmières de même que des mécanismes d'évaluation formelle doivent être mis en place, des efforts doivent être faits pour répartir équitablement les tâches, pour amener les infirmières à agir en tant que gestionnaires de cas et à se délester de tâches au profit des infirmières auxiliaires, et pour les sensibiliser à l'importance de la notion de prise en charge de sa santé par le client; des activités de formation continue significatives pour les infirmières doivent être élaborées à partir de l'analyse de leurs propres besoins et enfin des charges de travail particulières doivent être offertes aux infirmiàres de 55 ans et plus dans le but de les retenir au travail. / The results of this research done with middle managers who are the immediate superior to nurses working in programs for persons with loss of autonomy related to aging (PALV), also known as home care, show that it is difficult to attrack new nurses to these programs because of a lack of popularity in the field of geriatrics. In order to attrack candidates to these programs, the managers responsible for the organization of work could promote the challenge of managing health situations which are often complex, the flexible work hours, the autonomy that the nurses have in scheduling their route, the fewer weekends of work as compared to hospitals and the lack of obligatory overtime. According to the managers there are no more departures from these programs than for other programs. To further support this retention, managers must put into place a well developed orientation and structure for nurses, mechanisms must be instituted for formal performance evaluations,close attention must be paid to the equitable distribution of tasks, and efforts must be made to guide nurses to function as case mangers and to benefit from assigning tasks to nursing assistants. To sensitize them to the importance of the notion of the client taking charge of their health, pertinent continuing education activities must be developed and offered to nurses based on an analysis of their particular needs, and finally, specific workloads must be offered to nurses 55 years of age and older in order to keep them at work.

Objective: To examine the factorial validity of the Team Skills Scale (TSS). The TSS is a 17-item scale developed by Hepburn, Tsukuda, and Fasser (1996). The Scale is purported to assess self-perceived team skills.Data Source: Data for this study were provided by The New York University Geriatric Interdisciplinary Team Training (GITT) Resource Center and were collected as part of the evaluation of the GITT program. The data were collected between January 1997 and June 2000.Study Design: This quasi-experiential study was focused on the trainee (N=1,715) as the unit of analysis. The Model of Individual-Level Team Competencies (Model of I-LTC) served as the conceptual framework and guided a priori specification of the TSS confirmatory factor analysis measurement model. The Model of I-LTC was developed by this author based on review and interpretation of the team literature.Principal Findings: The TSS is a one-factor structure comprised of eight of the original 17 indicators. Also, the revised measurement model was found to be invariant when the data were randomly divided into two equal samples. Finally, the covariance structure model indicated that attitude about the physician as team leader and sole patient care decision-maker had a significant and negative association with variation in responses to the TSS. Attitude about the quality of team delivered patient care had a significant and positive association with variation in responses to the TSS.Conclusion: This study found that the TSS in a single factor structure comprised of eightof the original 17 TSS items. It is believed that the eight items measure self-perceivedteam collaboration skills. Although the factor structure was confirmed by the data, thisdoes not mean that the proposed structure is absolute. It just means that the structure hasnot been falsified. However, it is possible that this constellation of indicators was datadriven. Therefore, further psychometric testing, to include the use of other data sources,is recommended.

The problem with which this study is concerned is that of ascertaining the effects of intensive Remotivation Techniques on institutionalized geriatric mental patients in terms of their ward behavior, self-concept, and visual-motor perceptions and to compare these with the effects of a similar group experience that does not emphasize patient-staff or patient-patient interactions, and a third group which acts a a control. The investigation is designed to answer or obtain information concerning the following questions: (1) Do institutionalized geriatric mental patients in a state mental hospital manifest measurable changes in terms of their (A) ward behavior as defined as raw scores on the Hospital tment Scale (including interpersonal communication and interpersonal relations; self care and social responsibility; level of participation in ward activities, recreation and work therapy; total score), (B) self-concept as defined as Goodenough raw scores on the Draw-a-Person Test, and (C) awareness of environment as defined as Pascal and Suttell raw scores on the Bender Visual-Motor Gestalt Test, as a result of experiencing the social and verbal interactions of intensive Remotivation Techniques? (2) Is the Remotivation Technique more effective in producing these changes than a similar group experience that does not emphasize social and verbal interactions?

Introduction: Propotion of older people is rapidly increasing in the world population. Elderly represents a specific, heterogenous population which is because of many reasons more vulnerable to some adverse drug events. Many explicit criteria of potentially inappropriate medication used in the elderly have been developed in order to improve the quality and safety of geriatric pharmacotherapy. These criteria represent basic tools, defining fundamental prescribing rules for the evaluation of appropriate choice and dosing of medications in the old age and for the evaluation of potentially inappropriate prescriptions in older patiens. The aim of the diploma thesis was to compare advantages and disadvantages of explicit criteria published until the end of 2015 year and to summarizea list of allpotentially inappropriate medications in the elderly (regardless of diagnoses and concomitantly used medications), applicable in the epidemiological studies of the EU COST Action 1402project and in subsequent studies. Methods: Using systematic literature search in PubMed dataset, conducted in the period 04/2015 - 12/2015, all explicit and explicit- implicit criteria (published in the foreign peer- reviewed scientific journals bythe end of year 2015 and validated by expert panels) have been identified. Information...

Many researches are focused on the study of depression in older age, their results show a negative impact of depression on the cognition of the elderly. There are not many studies that focus on geriatric anxiety and their results are often contradictory. In the theoretical part, this thesis aims to provide an insight into the anxiety from the philosophical and clinical standpoint, and in particular to describe the specifics of the geriatric anxiety and various areas of human life that may affect it. The practical part presents the results of 279 participants of the NANOK study aged 60-92 years, the analysis focuses on the effects of anxiety symptoms on cognition, taking into account depressive symptoms. Significant differences in healthy elderly persons are found only in the tests of immediate and delayed recall, no significant differences are found in the attention and executive functions tests. Various ways of influencing cognition by anxiety are discussed. In our sample of healthy older people, the rate of anxiety symtoms was not associated with the level of cognitive performance. Keywords: elderly; cognition; depression; anxiety; screening; Geriatric Anxiety Inventory; GAI

Le cancer du sujet âgé est un réel problème de santé publique. L’incidence du cancer augmentant avec l’âge couplée au vieillissement général de la population font que plus de la moitié des tumeurs diagnostiquées aujourd’hui le sont chez des patients de plus de 65 ans. Cependant, cette population hétérogène a longtemps été exclue des essais cliniques et le manque de données prospectives rend difficile la prise en charge de ces patients. Plusieurs publications soulignent l’importance et la complexité de réaliser des essais cliniques dans cette population. Les schémas classiques ne prenant pas en compte l’hétérogénéité, les essais de phase II spécifiques aux sujets âgés sont rares et généralement stratifiés en sous-groupes définis selon un critère gériatrique ce qui augmente le nombre de patients à inclure et donc diminue la faisabilité. L’objectif de cette thèse est de présenter, comparer et développer des schémas de phase II adaptatifs stratifiés permettant de prendre en compte l’hétérogénéité de la population âgée. L’utilisation de ce type d’approche permet de réduire le nombre de patients à inclure tout en maintenant la puissance statistique et en contrôlant le risque d’erreur de type I. Ce qui implique une diminution du coût et de la durée de l’étude et donc une augmentation de la faisabilité. Afin d’améliorer l’efficacité de la recherche clinique en oncogériatrie, il est donc primordial d’utiliser des schémas adaptatifs stratifiés prenant en compte l’hétérogénéité de la population et permettant d’identifier un sous-groupe d’intérêt susceptible de pouvoir bénéficier (ou non) de la nouvelle thérapeutique. / Elderly cancer is a real public health problem. With the overall aging population and the increased incidence of cancer, more than half of all tumors diagnosed today are in patients aged 65 years or older. However, this heterogeneous population has long been excluded from clinical trials and the lack from prospective data makes it difficult managing these patients. Many publications highlight the importance and the complexity of conducting clinical trials in this population. As classical phase II designs do not take into account the heterogeneity, elderly specific phase II clinical trials are very uncommon and generally conducted in specific subgroups defined by geriatric criteria which increases the number of patients to be included and thus reduces the feasibility. The objective of this thesis is to present, compare and develop stratified adaptive designs that address the heterogeneity of the elderly population. The use of this methodology can minimize the number of patients to be included while maintaining statistical power and controlling the type I error risk. This implies a reduction in the cost and duration of the study and thus increases the feasibility. In order to improve the efficiency of clinical research in geriatric oncology, it is essential to use stratified adaptive designs that take into account the heterogeneity of the population and make it possible to identify a subgroup of interest that might benefit (or not) from the new therapeutic.

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